This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Google Scholar Articles by Casarett, D. Articles by Asch, D. A. PubMed PubMed Citation Articles by Casarett, D. Articles by Asch, D. A.

How Should We Design Supportive Cancer Care? The Patient's Perspective

David Casarett, Jessica Fishman, Peter J. O'Dwyer, Frances K. Barg, Mary Naylor, David A. Asch

From the VA Center for Health Equity Research and Promotion, the Leonard Davis Institute of Health Economics, and the University of Pennsylvania Schools of Medicine and Nursing, Philadelphia, PA

Corresponding author: David Casarett, MD, University of Pennsylvania, 3615 Chestnut St, Philadelphia, PA 19104; e-mail: casarett{at}mail.med.upenn.edu

Purpose: Hospice services are designed to meet the needs of patients near the end of life. Although so-called open-access hospice programs and bridge programs are beginning to offer these services to patients who are still receiving treatment, it is not known whether they best meet patients’ needs.

Patients and Methods: Three hundred adult patients receiving treatment for cancer completed interviews in which each patient's value or ability for supportive care services were calculated from the choices that they made among combinations of those services. Preferences for five traditional hospice services and six alternative supportive care services were measured, and patients were followed up for 6 months or until death.

Results: Patients’ utilities for alternative services were higher than those for traditional hospice services (0.53 v 0.39; sign-rank test P < .001). Alternative services were also preferred among patients with poor functional status (Eastern Cooperative Oncology Group performance score > 2; n = 54; 0.65 v 0.48; P < .001) and among those who were in the last 6 months of life (0.68 v 0.56; sign-rank test P = .003). Even patients who were willing to forgo cancer treatment (n = 38; 13%) preferred alternative services (3.1 v 1.8; P < .001).

Conclusion: Patients who are receiving active treatment for cancer, and even those who are willing to stop treatment, express a clear preference for alternative supportive care services over traditional hospice services. Supportive care programs for patients with advanced cancer should reconsider the services that they offer and might seek to include novel services in addition to, or perhaps instead of, traditional hospice services.

Supported by Grant No. R01CA109540, by a VA Advanced Research Career Development Award, and by a Presidential Early Career Award for Scientists and Engineers (D.J.C.).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.